Verschiedene Indikationen der photodynamischen Therapie in der Augenheilkunde

Zusammenfassung

Hintergrund: Die photodynamische Therapie (PDT) mit Verteporfin am Auge wurde als Therapie der neovaskulären Form der altersabhängigen Makuladegeneration (AMD) vor 10 Jahren eingeführt. Danach erfolgte die Zulassung der PDT für chorioidale Neovaskularisationen (CNV) im Rahmen der pathologischen Myopie. Die Therapieempfehlungen zur AMD basieren auf den Ergebnissen zweier prospektiver, multizentrischer Studien (TAP- und VIP-Studie). Material und Methoden: In der Zwischenzeit wurde die PDT am Auge auch bei zahlreichen anderen Erkrankungen mit zum Teil bemerkenswertem Erfolg angewandt. Sie ist minimalinvasiv und hat geringe Nebenwirkungen. Verschiedene Erkrankungen und ihre Behandlung mit der PDT werden dargestellt. Ergebnisse: Die Durchführung der PDT als Behandlungsmethode bei idiopathischer CNV, bei CNV im Rahmen von inflammatorischen Netzhaut-Aderhauterkrankungen, chorioidalen Hämangiomen, vasoproliferativen Tumoren der Netzhaut, beim Aderhautmelanom und der Chorioretinopathia centralis serosa wird beschrieben. Bei den meisten Patienten kann die Progredienz der Erkrankung aufgehalten werden und bei einem Teil der Patienten kommt es zu einer Visusverbesserung. Die Aussichten sind umso besser, je früher die Behandlung erfolgt und je kleiner die Läsion ist. Schlussfolgerung: Zahlreiche Netzhaut-Aderhauterkrankungen können erfolgreich mit einer PDT behandelt werden. Allerdings ist diese Therapieform außer bei AMD und pathologischer Myopie off-label.

Abstract

Background: Photodynamic therapy (PDT) in eye disease was approved 10 years ago for age-related macular degeneration (AMD). Thereafter it was approved for choroidal neovascularisation (CNV) in pathological myopia. The treatment regimen is based on two prospective, multicentre trials (TAP and VIP studies). Material and Methods: In the meantime PDT has been successfully used also in several other ocular diseases. PDT is minimally invasive and has an excellent side effect profile. Different diseases and their treatment with PDT are discussed. Results: The treatments of idiopathic CNV, secondary CNV in inflammatory diseases of the retina and choroid, choroidal haemangioma, vasoproliferative tumours, malignant melanoma of the choroid, and central serous chorioretinopathy with PDT are described. In most patients the disease progression can be stopped and in some the PDT treatment results in visual improvement. The prognosis is better in patients with early disease detection and small lesions. Conclusion: Several retinal and choroidal diseases can be treated successfully with PDT. Except for AMD and pathological myopia, PDT is an off label treatment.

Schlüsselwörter

photodynamische Therapie - idiopathische CNV - Hämangiome - malignes Melanom der Aderhaut - Uveitis - Chorioretinopathia centralis serosa

Key words

photodynamic therapy - idiopathic CNV - haemangioma - choroidal malignant melanoma - uveitis - central serous chorioretionpathy

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